Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Holter system electrocardiograms were recorded for 617 patients who were treated at the Department of Cardiology, Tokai University Hospital. In cases of arrhythmia, ventricular premature contraction (VPC) was the most predominant, in 291 cases (69%) out of 423 with arrhythmia, followed by 59 (14%) with supraventricular premature contraction (SVPC), 23 (5.4%) with paroxysmal atrial tachycardia, 17 (4%) with second degree A-V block and 10 (2.3%) with transient atrial fibrillation (AF). In addition, nine (2.1%) cases of ventricular tachycardia (VT), one (0.2%) of transient ventricular fibrillation (VF) and one (0.2%) of third degree A-V block were found in particularly severe arrhythmia cases. Six out of nine cases of VT were cases of acute myocardial infarction (AMI) and all died suddenly while in the hospital or after discharge. Mild or moderate changes in ST-T were often observed even in normal subjects. Of the 617 cases, only 18 (2.9%) showed a significant elevation or depression of ST. Among these, three definitely had variant angina pectoris (Prinzmetal type). The above results indicate Holter EKGs are very useful for the diagnosis of arrhythmia and can also be used as a means of evaluating the prognosis in some cases, but there still are some problems in connection with its use for the diagnosis of ischemic heart disease except for the diagnosis of variant angina pectoris.
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PMID:Holter system electrocardiographic studies on 617 cases. 738 65

To establish a safe and sensitive diagnostic procedure for detecting coronary vasospasm, we utilized 201-thallium myocardial SPECT combined with hyperventilation (HV-SPECT) in 29 patients with vasospastic angina (VAP) and 11 controls. Twenty-five of 29 patients with VAP and 5 of 11 controls developed transient perfusion defects on HV-SPECT, resulting in a sensitivity and specificity calculated at 86% and 55%, respectively. Overall accuracy in identifying corresponding vessels with coronary vasospasm, respectively. Coronary vasospasm tended to be identified more accurately in the left anterior descending branch and the right coronary artery than in the circumflex branch (75%, 71% and 50%, respectively). The hyperventilation test induced ischemic ECG changes in 11 of 29 patients with VAP, yielding a sensitivity of 38%. Analyzing the washout rate of HV-SPECT in patients with VAP, both the extent and severity scores of patients with ischemic ECG changes were larger than those of patients without. No serious complications occurred during HV-SPECT. In conclusion, HV-SPECT was a safe and sensitive procedure as a primary diagnostic approach for VAP. From the results of washout analysis, HV-SPECT could detect more mild myocardial ischemia than could the ECG, and seemed quite useful especially for detecting coronary vasospasm accompanied by minimal ischemic ECG changes.
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PMID:Usefulness of hyperventilation thallium-201 single photon emission computed tomography for the diagnosis of vasospastic angina. 747 57

Hyperventilation Thallium-201 imaging was evaluated for the examination of the existence of ischemia in the cases of diffuse vasoconstriction under the ergonovine maleate provocative test for coronary artery. Transient myocardial perfusion defect (PD) was demonstrated in 14 patients with ergonovine induced vasospasm (group S), and 13 of these patients also demonstrated redistribution (RD) (92.4%). In 14 patients with diffuse vasoconstriction (group D), nine demonstrated PD, and all of them revealed RD. On the other hand, only one of ten (10%) patients demonstrated PD and RD in a group of patients without spasm or diffuse vasoconstriction (group N). In addition, the left ventricular myocardium was divided into nine segments on a SPECT image, and the mean minimum washout rate (WOR) of each segment was evaluated. These values were compared with the percent change of the lung/heart ratio between early and delayed images (delta L/H%). Both the mean minimum WOR mean and delta L/H% of group D were significantly smaller than that of group N (p < 0.001), and only approximated to group S. Thus, the possibility of myocardial ischemia of diffuse vasoconstrictive coronary artery is implicated and such patients are supposed to be treated medically as vasospastic angina.
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PMID:[Clinical significance of diffuse vasoconstriction of coronary arteries--a study using hyperventilation thallium-201 myocardial imaging]. 759 68

Clinical and experimental observations have confirmed that an episodic increase in the vasomotor tone of a major coronary artery may play a pathogenetic role not only in "variant angina" but also in other, more common anginal syndromes. In chronic stable angina, dynamic changes of vascular smooth muscle tone at the site of eccentric atheromatous plaques are responsible for "mixed angina." Abnormal coronary vasomotion contributes to myocardial ischemia in acute coronary syndromes as well. Studies have shown that a "primary" reduction of coronary blood flow, usually associated with plaque fissuring and thrombus formation, causes infarction and unstable angina. Abnormal vasoconstriction associated with the release of vasoactive substances by platelets and other constituents of the thrombus can contribute to coronary flow reduction in patients with unstable angina and myocardial infarction. Better understanding of the complex interactions among atherosclerotic coronary obstructions, the vascular smooth muscle, and the vascular endothelium has resulted in novel therapeutic approaches and has stimulated the search for more efficacious and safer coronary vasodilators. Recently interest has focused on vasodilator agents such as nicorandil that influence coronary arterial tone by acting through potassium channel activation. Nicorandil appears to be effective for treatment of vasospastic angina, as suggested by studies in Japan and Europe. In addition to its "antivasospastic" properties, nicorandil dilates coronary artery stenoses in patients with stable angina pectoris.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of vasospastic angina--role of nicorandil. 764 26

As the chest symptoms and electrocardiographic changes of hypertrophic cardiomyopathy are occasionally very similar to those of angina pectoris, there are some difficulties in the diagnosis and treatment of cases of ischemic heart disease associated with hypertrophic cardiomyopathy. Here we report a case of vasospastic angina pectoris associated with hypertrophic cardiomyopathy diagnosed by coronary spasm provocation test performed by intracoronary administration of acetylcholine. In the treatment of such cases, beta blockers, which have the effect of decreasing the oxygen demand of the heart and the potential to induce coronary spasm, must be administered carefully.
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PMID:Vasospastic angina pectoris associated with apical hypertrophic cardiomyopathy. 764 17

To characterize regional cardiac sympathetic dysfunction due to myocardial ischemia, we examined 123I-metaiodobenzylguanidine (MIBG) myocardial distribution of initial 15-min and 4-hr delayed SPECT images in 14 patients with recent myocardial infarction (MI), 25 patients with vasospastic angina which was angiographically proven with elgonovine maleate (Gp VSAP) and 16 patients with chest pain syndrome and normal CAG findings (GpCP). In those with MI, the study was serially done at 2 weeks after (Gp MI-1) and at 3 months after the onset of MI (Gp MI-2). We estimated regional tracer uptake in 20 segments of tomographic images by using a 4-point scoring system (0 = normal, 1 = mild, 2 = moderate, 3 = severe reduction) and calculated the total defect score (IDS). In all patients with MI, the area of reduced MIBG uptake was more extensive than the 201Tl perfusion defect in the acute stage (Gp MI-1) indicating the presence of viable but denervated myocardial tissue. Also, the MIBG defect was persistently observed from initial (TDS: 24 +/- 13) to delayed imaging (TDS: 26 +/- 12). However, in the chronic stage (Gp MI-2), the initial MIBG uptake improved (TDS: 18 +/- 9) but the delayed uptake remained almost the same (TDS: 22 +/- 10) indicating high washout of MIBG from the ischemic myocardium. Fourteen in Gp VSAP and 14 in Gp CP showed the regional MIBG defect in the delayed image more extensively than in the initial image indicating high washout of MIBG in the involved myocardial regions. These results suggest that neuronal uptake of MIBG is impaired in the acute stage of MI although neuronal retention of MIBG is predominantly impaired in the chronic stage of MI or in Gps VSAP and CP.
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PMID:[Characteristics of regional sympathetic dysfunction in acutely ischemic myocardium assessed by 123I-metaiodobenzylguanidine imaging: impairment of myocardial norepinephrine uptake or retention]. 767 74

Calcium channel blockers are used extensively in the treatment of the three major anginal syndromes. In the treatment of Prinzmetal's angina, their antivasospastic properties account for their therapeutic effectiveness. Calcium channel blockers are drugs of first choice in this syndrome. In chronic stable angina, calcium channel blockers may be used as monotherapy or in combination with beta-blockers and/or nitrates. In patients with unstable angina, reduction in the incidence of ischemic episodes produced by calcium channel blockers is well documented. Recent data suggest that calcium channel blockers should generally be used in combination with beta-blockers, nitrates and antithrombotic agents. Patients with ischemic heart disease often exhibit reduced ventricular function. All of the first generation calcium channel blockers exacerbate symptoms in patients with established heart failure and may precipitate heart failure, particularly when combined with beta-blockers. Second generation vascular-selective dihydropyridines have been introduced recently. Vascular selectivity determines the drug's degree of negative inotropic effect. Felodipine is one of the most vascular selective of the available dihydropyridines and has no negative inotropic effects at clinically administered doses. In a long term study, felodipine, 20 mg/day, abolished symptoms and chronic ischemic episodes in 81% of treated subjects with Prinzmetal's angina. In patients with stable angina, felodipine has been found to be effective either as monotherapy or in combination with beta-blockers. In patients with known or suspected ventricular dysfunction, vascular-selective dihydropyridines such as felodipine offer advantages over the nonselective calcium channel blockers, particularly in patients receiving beta-blockers.
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PMID:The evolving role of calcium channel blockers in the treatment of angina pectoris: focus on felodipine. 772 49

Coronary artery calcification (CAC) was easily demonstrated by plain CT-scan. The aim of this study was to clarify the clinical significance of CAC in cardiovascular diseases. The subjects were 90 patients with ischemic heart disease (30 myocardial infarction, 50 exertional angina pectoris and 10 variant form of angina pectoris; 46 males and 44 females, 68 +/- 10 y/o) and 50 patients without ischemic heart diseases (30 hypertension, 10 arrhythmia, 3 valvular disease, 2 cardiomyopathy, 2 congenital heart disease and 3 others; 25 males and 25 females 65 +/- 9 y/o). CAC and calcification of thoracic aorta were evaluated by plain CT-scan (1 second scan time and 5 mm slice). The relationship between CAC and other clinical features (age, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking, resting ECG, exercise stress ECG, aortic calcification and optic fundi) were studied. CAC were seen more frequently in patients with ischemic heart disease (63%), old age (67%), aortic calcification (70%) and positive exercise testing (64%). On the other hand, CAC were rare in variant angina (30%). In younger patients (under 70 y/o), CAC were seen more frequently in diabetic patients. But, in older patients, CAC were frequently in those with hyperlipidemia. These results suggested that CAC was associated with not only systemic arteriosclerosis, but also ischemic heart disease, except vasospastic angina. The prognostic value of CAC would be studied later.
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PMID:Clinical significance of coronary artery calcification. 779 Jul 45

The possibility of using alteration in the ventricular gradient (VG) to discern the presence of ischemic heart disease was studied in 30 patients with effort angina pectoris(AP), 21 with vasospastic angina (VSA), 21 with chest pain syndrome (CPS), and 20 healthy volunteers (control). The VG of each consecutive heart beat over a 22-sec interval was calculated by microcomputer from resting Frank-lead X, Y, Z scalar electrocardiograms. The mean values and standard deviations (SD) for the azimuth, elevation, and magnitude of the VG in each group were calculated. The SD and SD/mean ratios for each parameter were used as indices of VG alteration in the groups, and the indices were compared. The SD and SD/mean for the magnitude and elevation of VG were significantly greater in the AP group than in the CPS and control groups. The SD for the azimuth of VG was significantly greater in the AP group than in the CPS and control groups (p < 0.01). The SD and SD/mean for the magnitude of VG were greater in the AP group than in the VSA group (p < 0.01). The SD/mean for the elevation and magnitude of the VG were greater in the VSA group than in the control group (p < 0.01). The SD/mean of the magnitude of the VG was found to be the best index, as it was higher than the upper limit of the control group. The sensitivity and specificity were 80 and 91% (AP vs CPS, p < 0.001), and 43 and 91% (VSA vs CPS, not significant), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Alteration in ventricular gradient at rest in patients with ischemic heart disease]. 782 82

The expression unstable angina pectoris covers a wide range of clinical symptoms with different pathogenetic mechanisms and clinical outcome. Several forms of unstable angina pectoris, in particular progressive angina pectoris (crescendo angina) with chest pain at rest in a previously asymptomatic patient, progressive angina pectoris with chest pain at rest in a previously symptomatic patient, and chest pain at rest of at least 15 min duration without obvious trigger mechanisms have been distinguished. In simpler terms: one may also distinguish angina pectoris of recent onset, crescendo angina, and acute coronary insufficiency. Four risk factors appear to determine the prognosis in these patients: exercise-induced angina pectoris, multiple episodes of chest pain before hospitalization, electrocardiographic changes, and recurrent angina pectoris during hospitalization. Acute coronary insufficiency and nontransmural infarction have initially better prognosis than transmural infarction; however, recurrent cardiac events are more frequent in patients with nontransmural infarction, particularly in the elderly with persistent ECG changes, cardiac decompensation, and infarct extension. Unstable angina pectoris and myocardial ischemia after myocardial infarction are generally associated with a poorer prognosis. In contrast, recurrence of angina pectoris after PTCA (within the first six months) is most commonly due to restenosis and hence prognostically not of great importance. Unstable angina pectoris after coronary bypass surgery, however, is a prognostically unfavourable sign. Prognosis in patients with Prinzmetal angina is determined by the extent of coronary disease. In summary, long-term prognosis in patients with unstable angina pectoris depends heavily on the clinical presentation and the previous clinical history of the patient.
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PMID:[Long-term prognosis in unstable angina]. 788 60


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